‘Leaving no one behind’: reflections on the design of community-based HIV prevention for migrants in Johannesburg’s inner-city hostels and informal settlementsReportar como inadecuado

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BMC Public Health

, 17:482

First Online: 20 May 2017DOI: 10.1186-s12889-017-4351-3

Cite this article as: Scorgie, F., Vearey, J., Oliff, M. et al. BMC Public Health 2017 17: 482. doi:10.1186-s12889-017-4351-3


BackgroundUnmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors’ experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. It shows how formative research findings were incorporated into project design, substantially shifting the scope of the original project.

MethodsFormative research activities were undertaken to better understand the demand- and supply-side barriers to delivering HIV prevention activities within this community. These included community mapping, a baseline survey n = 1458 and client-simulation exercise in local public sector clinics. The intervention was designed and implemented in the study setting over a period of 18 months. Implementation was assessed by way of a process evaluation of selected project components.

ResultsThe project scope expanded to include women living in adjacent informal settlements. Concurrent sexual partnerships between these women and male hostel residents were common, and HIV prevalence was higher among women 56% than men 24%. Overwhelmingly, hostel residents were internal migrants from another province, and most felt ‘alienated’ from the rest of the city. While men prioritised the need for jobs, women were more concerned about water, sanitation, housing and poverty alleviation. Most women 70% regarded their community as unsafe cf. 47% of men. In the final intervention, project objectives were modified and HIV prevention activities were embedded within a broader health and development focus. ‘Community health clubs’ were established to build residents’ capacity to promote health and longer term well-being, and to initiate and sustain change within their communities.

ConclusionsTo improve efforts to address HIV in urban informal settings, intervention designers must acknowledge and engage with the priorities set by the marginalised communities that live here, which may well encompass more pressing issues associated with daily survival.

KeywordsUrban HIV South Africa Intervention design Migrants Informal settlements Gender AbbreviationsARTAntiretroviral therapy

MMCMedical male circumcision

NGONon-governmental organisation

PHCPrimary health care

PrEPPre-exposure prophylaxis

QLCQuality life club

SLASustainable livelihoods approach

SRHSexual and reproductive health

STISexually transmitted infection

VCTVoluntary counselling and testing

Autor: Fiona Scorgie - Jo Vearey - Monique Oliff - Jonathan Stadler - Emilie Venables - Matthew F. Chersich - Sinead Delany-Moret

Fuente: https://link.springer.com/

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